Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Diabetes and Severe Aortic Stenosis at High Risk for Surgery
Open accessAbstract
Objectives The goal of this study was to determine whether a less-invasive approach to aortic valve replacement (AVR) improves clinical outcomes in diabetic patients with aortic stenosis (AS).Background Diabetes is associated with increased morbidity and mortality after surgical AVR for AS.Methods Among treated patients with severe symptomatic AS at high risk for surgery in the PARTNER (Placement of Aortic Transcatheter Valve) trial, we examined outcomes stratified according to diabetes status of patients randomly assigned to receive transcatheter or surgical AVR. The primary outcome was all-cause mortality at 1 year.Results Among 657 patients enrolled in PARTNER who underwent treatment, there were 275 patients with diabetes (145 transcatheter, 130 surgical). There was a significant interaction between diabetes and treatment group for 1-year all-cause mortality (p = 0.048). Among diabetic patients, all-cause mortality at 1 year was 18.0% in the transcatheter group and 27.4% in the surgical group (hazard ratio: 0.60 [95% confidence interval: 0.36 to 0.99]; p = 0.04). Results were consistent among patients treated via transfemoral or transapical routes. In contrast, among nondiabetic patients, there was no significant difference in all-cause mortality at 1 year (p = 0.48). Among diabetic patients, the 1-year rates of stroke were similar between treatment groups (3.5% transcatheter vs. 3.5% surgery; p = 0.88), but the rate of renal failure requiring dialysis >30 days was lower in the transcatheter group (0% vs. 6.1%; p = 0.003).Conclusions Among patients with diabetes and severe symptomatic AS at high risk for surgery, this post-hoc stratified analysis of the PARTNER trial suggests there is a survival benefit, no increase in stroke, and less renal failure from treatment with transcatheter AVR compared with surgical AVR. (The PARTNER Trial: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).
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Results from some recent studies suggest that TAVR might be preferable to surgical aortic valve replacement in patients with diabetes, chronic obstructive pulmonary disease, pulmonary hypertension, small aortic annulus and low-flow, low-gradient aortic stenosis.
“Results from some recent studies suggest that TAVR might be preferable to surgical AVR in patients with diabetes, chronic obstructive pulmonary disease, pulmonary hypertension, small aortic annulus and low-flow, low-gradient AS262–266.”
From Calcific aortic stenosis (2016) · cites this paper as [262]
The Conclusion supports the diabetes portion of the claim: TAVR may be preferred over surgery for patients with aortic stenosis and diabetes. That finding comes from high-surgical-risk patients, a restriction the citing sentence omits. The other listed conditions are not attributed to this source alone within the citation range. (LLM, conf=0.85)
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- Authors
- Lindman, B. R., Pibarot, P., Arnold, S. V., Suri, R. M., McAndrew, T. C., Maniar, H. S., Zajarias, A., Kodali, S., Kirtane, A. J., Thourani, V. H., Tuzcu, E. M., Svensson, L. G., Waksman, R., Smith, C. R., & Leon, M. B.
- Affiliations
- Washington University in St. Louis (US)
- Saint Luke's Hospital (US)
- Mayo Clinic (US)
- Cardiovascular Research Foundation (US)
- NewYork–Presbyterian Hospital (US)
- Emory University (US)
- Cleveland Clinic (US)
- MedStar Washington Hospital Center (US)
- Corresponding author
- Lindman, Brian R.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2014-03
- Volume
- 63
- Issue
- 11
- Pages
- 1090-1099
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC3962709
- OpenAlex
- W2166688699
- Cited by
- 75
- References
- 28
- Citations by year
- 2025: 5 · 2024: 3 · 2023: 2 · 2022: 7 · 2021: 4 · 2020: 2 · 2019: 10 · 2018: 7 · 2017: 9 · 2016: 9 · 2015: 11 · 2014: 5 · 2013: 1
- FWCI
- 5.89
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Corpus Université Laval (Université Laval) (submittedVersion)
- Funders
- Edwards Lifesciences (K23 HL116660)
- Institute of Clinical and Translational Sciences (KL2 TR000450, UL1 TR000448)
- National Institutes of Health
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Keywords
- transcatheter aortic valve implantation, surgical aortic valve replacement, diabetes mellitus, severe aortic stenosis, high surgical risk, all-cause mortality, stroke, renal failure, PARTNER trial
- MeSH terms
- Age Factors, Aged, Aged, 80 and over, Aortic Valve Stenosis, Diabetes Mellitus, Type 2, Evaluation Studies as Topic, Female, Follow-Up Studies, Cardiac Catheterization, Heart Valve Prosthesis, Humans, Male, Postoperative Complications, Severity of Illness Index, Sex Factors, Echocardiography, Doppler, Survival Rate, Proportional Hazards Models, Treatment Outcome, Hospital Mortality, Risk Assessment, Statistics, Nonparametric, Minimally Invasive Surgical Procedures, Heart Valve Prosthesis Implantation, Kaplan-Meier Estimate
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